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BOX 23
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/ 'NAM COUNTY DEPARTMENT OF HEALTH
LION OF ENVIRONMENTAL HEALTH SERVICES—
�ICATE OF CONSTRUCTION COMPLIANCE F(RVS W ATMENT SYSTEM
` n �� �
CONSTRUCTION PERMIT # /' i 4. r Z C o L
LSD �. _�_._ _
.6cated at 1 Village
,f
/Owner /Applicant Name (//Ar Tax Map Block _�_ Lot /S •
Formerly Subdivision Name �,f_i 10®1147_l(/'
Subd. Lot # C2_ -'f
Mailing Address /c . 4V iJ j5 n,[ Q if 'a1'� �'� Zip
Date Construction Permit Issued by PCHD zl_ 15 Z---
leeV
Separate Sewerage System built by ,)eS1�i1?J'W Address / ' 5�AJ'
Consisting of Gallon Septic Tank and c/.,;3 i d i-'*
Other Requirements:
Water Sunnly: Public Supply From
Address
or: Private Supply Drilled by 17.0�4_Z— Address c�3rPf v ST/ 'y
.Bud ding Type. ��/�1� 4� � %G�_ , Has erosion, c¢ntrol, been.,campleted?
Number of Bedrooms Has garbage grinder been installed? Iyd
J certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulations of a Putnam Co ty D partment of Health.
Date: Certified by P.E. R.A.
-'e"4 — /es r essional)
Address r � i -fr P ate �� License #
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, i the judgment of the Public Health Director, such
revocation, modificatigno change is neceskary. l 1�2
White copy - HD File; Y
)/ Title:
- Building Inspector; Pink copy -
Date:
133
copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OIF HEALTH
IIDIIVIISIION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well T
150 Sunset Hill Road P
Town/V'illk&:` '" T
Tax Grid #
Well Owner: N
Name: Address:
Westchester Modular Homes, 1995 Route 22, Brewster, NY 10509
Use of Well: X
X Residential Public Supply Air cond/heat pump Irrigation
llDrilling ]Equipment X
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type S
Screened Open end casing X Open hole in bedrock Other
Casing Details L
Total length 122 ft. M
Materials: X Steel Plastic Other
Joints: _ Welded X Threaded _ Other
Seal: X Cement grout _ Bentonite Other
Drive shoe: X Yes No Liner _ Yes X No
Screen Details F
Diameter (in) S
Slot Size L
Length(ft) Depth to Screen (ft) D
Developed?
First Y
Yes No
Second H
Well Yield Test _
_ Bailed X Pumped X Compressed Air Hours 6 Y
Yield 30+ gpm
Depth Data M
Measure from land surface- static (specify ft) D
During yield test(ft) Depth of completed well in feet
Well Log D
Depth From S
Surface W
Water W
Well F
Formation
ft. f
ft. B
Land Surface 5
50 D
Drilling i
in over d
den clay and boulders
Hit rock a
at 50'
50 1
122 -
-Drillinq i
in rock s
set: easin , gk6uted. - --
122 2
245 D
Drilling i
in rock g
granite
If yield was tested F
Feet G
Gallons Per Minute P
Pump /Storage Tank Information
Pump Type sue_ Capacity 7anm
Date Well Completed P
Putnam County Certification No. D
Date of Report W
W:gm-
Exact location of well wttn arstances t t [east two permanent lanamancs to De provra on a separate sneevptan.
Well Driller's Name P, Address: 4 Putnw Aw., Brewster, W 10509
Signature: Date: 9/20/02
Perry o Beal
White copy: HD Fi ; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
&i u "I
CON- Siuui' s ENGINEERS
- "._ .: •. _ - .. �_ _ G ; psrutl J. _I�nahue R.E.
200 Dreckenrido Rbid
Mahopac, N.Y. 10541
914 -628 -7576
ro
WE ARE SENDING YOU C Attached C Under separate cover via the following Items:
C Shop drawings 0 Prints O Plans O Samples Q Specifications
C Copy of letter 0 change order
THESE ARE TRANSMITTED os checked
❑
For approval
O
For your use
G
As requested
! �r
For review and comment
❑
WE ARE SENDING YOU C Attached C Under separate cover via the following Items:
C Shop drawings 0 Prints O Plans O Samples Q Specifications
C Copy of letter 0 change order
THESE ARE TRANSMITTED os checked
❑
For approval
O
For your use
G
As requested
L
For review and comment
❑
FOR BIDS DUE
C Approved as submitted C Resubmit -00096 for approval
0, Approved as noted Q Submit copies for distribution
J Returned for corrections C Return corrected prints
14 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
a,
SIGNED:
..����.. wMr u• at
DANIEL J. DONAHIL LLJE, P.E.
CONSULTING ENGffl V3,. ERS
`120 Breckenridge Road
Mahopac, N.Y. 10541
845- 628 -7576
September 24, 2002
Putnam County Department of Health
Geneva Road
Brewster, N.Y. 10509
Att: Joseph Paravati, P.E.
RE: As Built SSTS -
Lot 2A Shedden Subdivision
Putnam Valley (T)
Dear Mr. Paravati:
Enclosed please find:
1. Certification of Construction Compliance
2. Well Log and Bacti Results
3. Guarantee and two copies
4. Three copies of the as built. Ian
.5. Filing fee of $200.00
6. E911 Verification Letter
Your prompt attention would be appreciated.
Sincerely
;;eI OJDonahue, P.E.
Site - Sanitary - Environmental
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Gr�l/�k�V
Z.L- / I.rl
Owner or Purchaser of Building Tax Map Block Lot
�� ST &a 46li/t7�
Building Constructed by
R Z)
Location - Street
Building Type
Cznoillage )
/ C L . /` / � - 1
Subdivision Name
J)_
Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the .owner, his successors, heirs or assigns, to place in good operating condition
any part of said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
�y system. _.. � .._ .._......., _.....�.__... _......_ _..,_.... _��:.......�...__.._.........._ ... _....�
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Dated: Month 7 Day Year
V �C
General Contractor (Owner) - Signature
Corporation Name (if corporation)
Signature
Title:
to 4 L;&
Corporation Name (if corporation)
Address: ! �is %2 7- Z Z �r�v i � Address:/S2 5- /f T Z L-A
State /) Zip A State Zip `o.L019'
Form GS -97
JMS.ENVIRONMENTAL SERVICES, INC.
1500 SUMMER STREET
M S STAMFORD, CONNECTICUT o69o5_ _ NELAC, CT and NY State Certified Environmental LabQratory
Bailing Information: Collector's Information:
Name: PF Beal & Sons Client: Westchester Modular Flame: Chris Beal
Address: 4 Putnam Ave Address of site: 150 Sunset Hill Rd
City: Brewster City: Putnam Valley
State: NY Zip: 10509 State: NY Zip:
Telephone:. 845-279-2460 Fax: 845-279-6613 Telephone:
Sample's Information:
Site: bathroom tap
Preservative: N/A
Temperature: <4C
Date Collected: 9/16/02 Date Received: 9/17/02
Time Collected: 15:00 Time Received: 11:30
Lab No.: J023415
Date Analyzed Test Name Result MCL Method
9/17/2002 15:00
Total Coliform
9/17/2002
Chlorine Free Residual
9/18/02
Color
9/18/02
Odor
9/18/02
Iron
9/18/02
Manganese
9/18/02
Sodium
9/18/02
Chloride
9/18/02
Hardness _
9/18102:'--
Nitrate— ._: �.._._..._ ..... _. _
9/18/0212:00
Nitrite
9/17/02
pH
9/18/02
Sulfate
9/18/02
Turbidity
9/18/02
Lead
Absent
Absent
SMWW 9222B
<0.1 mg /L
N/A
SMWW 4500CIG
ND
15 Units
SMWW 2120 B
ND
3 TONs
SMWW 2150 B
<0.03 mg /L
0.3 mg /L
SMWW 3111 B
<0.01 mg /L
0.3 mg /L
SMWW 3111B
17.2 mg/L
N/A
SMWW 3111 B
40 mg /L
250 mg /L
SMWW 4500 Cl C
_ 60 m /L
9.
N/A .
SMWW 2340 C
-1.67r mg/L
.-1,0-mg /L' .....
• - SMWW -4%0 NO3E.._
<0.1 mg /L
1.0 mg /L
SMWW 4500 NO3E
7.12 S.U.
6.5 -8.5 S.U.
SMWW 4500 H B
6.65 mg /L
250 mg /L
SMWW 4500 SO4F
0.77 NTU
5 NTUs
SMWW 2130 B
<1.0 ug/L
15 ug /L
SMWW 3113 B
At the time of analysis the sample was acceptable for total coliform
N/A =Plot Applicable mg /L- milligrams per Liter ND- None Detected
S.U.= Standard Unit NTU- Nephelometric Turbidity Unit
MCL- Max. Contaminant Level TON- Threshold Odor Number
ug/L- micrograms per Liter
6 r ,
Signature: State #: PH -0218
Michael Lapman FLAP #: 11715
President
Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com
BRUCE
Public Health Director
: L-.ORETTA. M01.TNARI R-N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (9.14) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
OW14ERS NAME:
TAX MAP NUMBER:
E911 ADDRESS:
TOWN:
AUTHORIZED TOWN OF
(Signature)
DATE:
WW-,k 4ti i7��U In�� NAnI G�
The Putnam County Department of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, i.e., a legal E911
address is,assigned.by an authorized town official. This form is to be�submitted
with the application for a Certificate of Construction Compliance.
(911VERFRM)
� T L COUNTY D M g OF
I mo, a OF ENVIRONMENTAL HEj SERVICES
dU STRUCTION PERMIT FOR Si A! I Ii ► \IM1 \► SYSTEM
Located at
WIMP-5
Subdivision nameJ'A*eA9PPJ Subd. Lot #
Date Subdivision Approved S2� 0j I,?
Owner /Applicant Name Aipz'Gl%
0ownr Village ty! &V
Tax Map 6— —/Block Lot O
Renewal Revision
Date of Previous Approval - -�
Mailing Address Za Cep , j(� Zip
Amount of Fee Enclosed
Building Type Lot Area YeNo. of Bedrooms _-�tDesign Flow GPD
IFi89 Section Only Depth VoRume
PCID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separgite Sewer - e System to consist of gallon septic tank and
n17 // 4 �r (6 � A ,9C D �I �G��3¢. 'y% 1 A
Other Requirements:
To be constructed by Address
Wateir Sniaabq Public Supply From Address
PP Y Y ..... _
®�: -- � private -Su � 1 Drilled b �� � _�.�.. _:. �. _.. _....._. --Address..,
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment sy em described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: P.E. R.A. Date"'`
Address B2o¢eX License #
APPROVED FOR CONSTRUCTION: This.approval expires two years from the date issued unless construction of the
sewage treatment system, as been completed`andInspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the.Public Health Director. Any revision or alteration of the approved plan requires
a new jermit. Approv for.discharge`of domestic sanitary sew ge only.
By: e i P Title: Date: ' oz=
White copy - HD F e; Ye 1 w copy - Building Inspector; Pink copy - O er; O copy - Design Professional
Form CP -97
. PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # P'-
Located at
C Rd
Subdivision nameX #0040�0 Subd. Lot #
Date Subdivision Approved eL l7 `?
Owner /Applicant Name K/ 11 zVe, % &/
DTownr Village eA 4go/ %' 11.ey
Tax Map / Block Lot
Renewal Revision:
Date of Previous Approval ,f W ,9M.,
Mailing Address /0;� Dooy !71P Zip
Amount of Fee Enclosed
t
Building Type •. Lot Area No. of Bedrooms _i7esign Flow GPD_4F�Z
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Seaarate Sewerage System to consist of gallon - septic tank and
Other Requirements: "'
To be constructed by Address
Water Supply:. Public Supply From Address
...or.: _ P-'1Zvare:Siip I' Drilled b / /�� ... _ ...�. -- _.A- ddress
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval .of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: P.E. R.A. Date 7/-2-2; 4100
0.
Address 101d /�itG�•n ✓f f!� Icy A-01P License #
APPROVED FOR CONSTRUC IONi This,$pproval expires two years from the date issued unless construction of the
sewage treatment system `has been comiAtted aiid"inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the,Public Health Director. Any revision or alteration of the approved plan requires
a new permit. Approved for discharge of domfstic sanitary sewage only.
By: Title:
,Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
-v
T T ! ! i
PUTNAM COUNTY HEALTH DEPT. 024096
` 1 Geneva Road (845) 278.6130
Brewster, NY 10509
Date `Zf�3 /a�
Received ofda,w ✓
The Sum Of �- Dollars $ M-100 .
For •
THANK YOU!
❑ Cash Check erm.o. ❑ Credit Card By //i;7 - - a
i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
.:,....,.. - -.__- .._ -... CONSTRUCTION`PERMIT FOR:S,EWAU TREATMCNT SYSTEM
PERMIT #
Located at
Subdivision name kr "APA*V Subd. Lot #oZ-,00-
Date Subdivision Approved��g'
Owner /Applicant Name A)i/G /C*"*y
r4D Village AA
Tax Map 4 Z Block f _ Lot l�
Renewal Revision L--'
Date of�Previous Approval 'PA-Ad /
Mailing Address f �- /�� �}�/ &4 /��/� �✓ �� /1. -f• Zip -Z—AjW
Amount of Fee Enclosed
Building Typai //yt`l�i�'� /�'/ Lot Area, No. of Bedrooms Design Flow GPD
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of anot gallon septic tank and
Other Requirements:
To be constructed by ��� Address
Water Supply: Public Supply From Address
- - . or• Pnvate Supply Drilled by _ rtAddress— .
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
ccance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
,thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: P.E.
A--***" R.A. Date I-r—lzlop Z
4 License # ��r2/
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected . by the PCHD, and'is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe it. Approved f r discharge of domestic sanitary. sewage only.
By: 4 / Title: Date:'"z�'�
White copy - HD Fi e; Y41o4 copy - Building Inspector; Pink co - Owner; Orange copy - Design Professional
Form CP -97
PUTNAM (COUNTY DEPARTMENT ENT 07 HEALTH
DIVISION OF ENVIRONMENTAL ONMENTAIL H EAILTH SERVICES
APII LI<C_ATION ' '0 CONSTRUCT A:WAT ER WELL �J
-please pirnf or type - e _ - . _ • ... , .. _ „ PCH: D Permit #
Welll Location:
Street Address: %pw.Nillage Tax Grid #
Block/' Lot(s )/r /
Well Owner:
Name:
Address:
Use of Well:
W Residential Public Supply Air /Cond/Heat Pump Irrigation
I- Amary
Business Farm Test/Monitoring Other (specify)
Z secondzry
Industrial Institutional Standby
Amount of Use
Yield Sought gpm kPW erved Est. of Daily Usage 'gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
IlDetanled Reason
& &a, 62 Dee 0 e'
for pDARRing
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes &" No
Name of subdivision ,AG O- mpoy Lot No.
_
Water Well Contractor: dn7D Address:
Is Public Water Supply available to site? .................................. ............................... Yes No
Name of Public Water Supply: d a Town/Village
Distance to property from nearest water main: A, r `
Proposed well location & sources of contamination to rovided on se ate sheet/plan.
Date:_ Applicant Signature: -_
PUNT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County.
Date of Issue J —Z 3 `- Permi
Date of Expiration 5 —Z -'3 -f? Title:
Permit is Non-Transferrable
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
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Date Subdivision Approv
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Owner/Applicant Name n.111, T"Auji
777M k"
Amount of Fee Enclosed V
'Type Lot Area-
Building
LW
Se e e 07
OZI0.
provedamendmeq
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blic Health Director wil
his successors, heirs or ass
s by
Id
--�Aai sewage treatment system during the petii
-.d-approval of the Certificate of Construction Complian&6Qf,�
Sk
Signk
License #
,�pproval expires two years from the date issued unlesscoristr fl-to il
sewage treatment system if9s 6een % Pfqte ' , A&inspected by the PCHD and is revocable for cause or
may v en q
modified when considered necessary by the,PpWic Health Director. Any revision or alteration of the, 'approved, I''
or-discharge of-4�0i�pgtic sanitary sewage only.
a new permit. Approved f
By: Title: Date:
White COPY - HP File; Yellow copy - Building Inspector; Pink copy - Owner; Orange6opy - Design Pro&ss..
Date Subdivision Approved
Owner/Applicant Name
Mailing Address /OP- 4VIORAI
Amount of Fee Enclosed
BuildingType Lot A
Fill Section
I
-4,
ro o s e d, 9 y 9i 6M
proved;
arniMNS, f
partment of Health, and,
#
--te blic Health Director. wiff:
001 his successors, heirs or assigns by thd'
X,
C,
d sewage treatment system during the petio4,`6f--,-
V
0 -,,-d 'approval of the Certificate of Construction Compliance:(
SN 15,
Sign(, P.E. R.A. Date; 21
Addres' re
2h 004.E.1010o* License #
A,
APPROVED FOR COL4STAUqj0Ni .is proval expires two years from the date issued unless- cofistj
sewage treatment system i6s �ie6n: % jNte ;Ad;inspected by the PCHD and is revocable for cause or may 51
modified when considered necessary by the RplAic Health Director. Any revision or alteration of the, approved
a new permit. Approved for discharge of'dO'4eAic sanitary sewage only.
By: Title: Date:
White copy - HP File; Yellow copy - Building Inspector; Pink copy - Owner; Orange6opy - Design Profess I
DANIEL J. DONAHUE, P.E.
CONSULTIN_ G ENGINEERS -
_
120 Breckenridge Road
Mahopac, N.Y. 10541
845- 628 -7576
July 22, 2002
Putnam County department of health
Geneva Road
Brewster, N.Y. 10579
RE: SSTS Revision
Property of Wulkan
Sunset Hill Road
Putnam Valley
AT: Shawn Rogan
Dear Mr. Rogan:
Enclosed please find a certified check for $150.00 along with permit to construct
application and three sets of-pips for a revised well location on the above captioned site.
Your prompt attention would be appreciated.
:._ _:_ .:. ...... el J. Donahue,�P.E. -.:._:...... _...�., .._ _.:....�.___.._ __ .. - ..._. ._:.:..__...:.:_....___.�.. _::. �.�. -� - -• -- ......_..�....._ .......
' •S
Site • Sanitary • Environmental
PiloDANIEL J. DONAHUE, P.E.
CONSULTING ENGINEERS
120 Breckenridge Road
845-628.7576
May 1, 2002
Putnam County department of health
Geneva Road
Brewster, N.Y. 10579
RE: SSTS Revision
Property of Shedden
Sunset Hill Road
Putnam Valley
AT: Shawn Rogan
Dear Mr. Rogan:
Enclosed please find:
1. Application for arievised permit for both a drilled well and SSTS.
2. Letter of Authorization
3. Certified check. for $150.00
4. ' Design data sheet
5. Three sets of revised plans
6. Two sets of house plans. Please .return -the: stamped set..
Comments: The new owner has proposed to relocate- the house and expand it to four
bedrooms the enclosed plans reflect these changes. Your prompt attention would be
appreciated. .
Sincerely;
Daniel J. Donahue, P.E.
Site - Sanitary - Environmental
D d'�'6.
P; A 3 COUNTY D i as OF
{ r y
HEALTH
--,....-,,DIVIS.ION.-.Of-.ENV-IRON-MENTA 7
LETTER OF AUTHORUZATRON
RE: Property of 0 4 �q .s /I% c r Lt%c� Ile" �
Located at /SAC' S um s g /-�i /� �P a! �r, .262,2.-n M4i11,011G, y
T/V (, Tax Map # 6,2 Block _ Lot
Subdivision of 5Li P &I&I e r,
Subdivision Lot # g Filed Map # Date Filed
Gentlemen:
This letter is to authorize IQ040AL4.10 � PE:-
a duly licensed Professional Engineer or Registered Architect to apply for the required
wastewater treatment,and/or water supply permits) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on nay behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
-conformity with the provisions of Article lay and/or 147 of the Education Law, the Public Health
Lam; grid the Putnam. County _Sanitary- Code:•
Countersigned:
• 4 &A.,
Very truly yours,
(owner
Mailing Address 1 LL&:_ - i ® Mailing Addgess:.12 r��., ,Qr. --
State / zip -��
Telephone:
EFIWAM
i
Telephone:
.r
Form LA -97
Zz :si zo /ee /v0
r-
PUTNAAM COUNTY DEPARTMENT OF HEALTH
DIVISION Of ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SU[ BSURFACE SEWAGE TREATMENT SYSTEM
Owner L Q i. vG t 4N Address, ,Q_ faAr,,1 doe ��'r,,t • A•G�
Located at (Street) I,,� A/. Tax Map 4L Block �_ Lot
(indicate nearest cross street)
Municipality Drainage Basin G.411,0VoA-�-J' ,?oe_0ot_<
SOIL PERCOLATION TEST DATA
Date of Pre- soaking //.2,/D 2- Date of Percolation Test 2A 2--
NOTES: 1. -tests to 0o mpeaLzu a% awuv r --I'- - - TO 0C
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31.60 min/inc a a
submitted for review.
2. Depth measurements to be made from top of hole-
Form DD-97
De of to Water
Water
Hole No.
Run No.
Time
Start - Stop
Eta Time
win.)
From Ground
Surface (Inches)
Start Stop
Lvel
Q17 In
ladies
Percolation
to
MNuech
10
°
3 0
�� '
c2
2-
2
3.r-/0 a ,-
3a
3
�o
/D�ro
3v
z as-14
4
5
3
/d
3�
,� y J'r �
4
'��
3 0
�f
�-
5
2
3
4
iv anual nercolation
rates are
obtained at eac!
NOTES: 1. -tests to 0o mpeaLzu a% awuv r --I'- - - TO 0C
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31.60 min/inc a a
submitted for review.
2. Depth measurements to be made from top of hole-
Form DD-97
DEPTH
G.L.
0.51
1.01
1.51
2.01
2.5'
3.0'
3.5'
4.0'
4.51
5.01
6.0'
6.51
7.09
7.51
8.01
8.51
9.01
9.51
10.01
Kj
RE, CEIvED er
TEST Pff DATA DU-t-
DES CRIPTION OF SOILS FNCOUiNTE]Ri*�'��,q"fi�017HOUS
VC-S
02 ' t1AY—j-PPj4WJ ENO,
—
, .---...
HOLE NO -
H
OLE NO. ----------
--------------
Indicate level at which groundwater is encotntered
Indicate level at which mottling is obsemcd
Indicate level to which Water level rises aft —7
er being encountered
Deep hole. observations made by:
Date
[On
Desf,g—n Professional C:
Address: I A/Vr X .r/,
y10
e S
D C",
Simature:
tin
PIMfessionalls seal 49-A�"" iF 0 C "F N
F I
t"
V PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF.ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGEr- SYSTEM
PERMIT #
Located at _ 4n f'-e:' Village nG
Subdivision namekde., Subd. Lot # �2 Tax Mape4 Block / Lot Id. /
Date Subdivision Approved � _ Renewal_ Revision
Owner /Applicant Name ✓a/ Date of Previous Approval
Mailing Address f��L/��/.��¢b!d%V% /?— �j'c -.�,� /%� Zipld',J�� -�
Amount of Fee Enclosed
Buildin g Type �la� Lot Are o/,_��No. of Bedrooms Design Flow GPD�
Fill Section Only Depth Volume
Separate Sewerage System to consist of l0 Z G gallon septic tank and
Other Requirements:
To be constructed by ' % B Address
Water Supply:. Public Supply From Address
or �C Private Supply Drilled by _T19 Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: P.E. L-`" R.A. D;Wt
Address /� r lG �c �, �j•.c 0J A,'o It r 1"� License #
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe i App ved o &ch6e o omestic sanitary sewa only.
By: Ti Date: Z
White copy - HD File; Yellow copy Biiilding Inspector- copy - Owner; Orange copy - Design Profes ional
'ZS "` Form CP -97
EUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERV110ES
PPLI<CA1['1t ®1`l ')<'O- Cc�1�1S' RU(� 'II' _A WA�'Ell8 W EII L �Z
please print or type PCHD Permit
Well Location:
Street Address: To illage Tax Grid #
N I && Map l
Block Lot(s)� r
Well owner:
Name:
Address:
Zy
Use Of Well:
� Residential Public Supply Air /Cond/Heat Pump Irrigation
Primary
Business Farm Test/Monitoring
Other (specify)
2- secondary
Industrial Institute nal Standby
Amount of Use
Yield Sought �gpm a ed Est. of Daily Usage ajgd gal.
Reason for
Replace Existing Supply Test/Observation
Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
AJe At f mod`
for Drilling
Well Type
Tilled Driven Gravel
Other
Is well site subject to flooding? ................................................. ...............................
Yes No
Is well located in a realty subdivision? ...................................... ...............................
Yes — Z--' No
Name of subdivision �f
Lod No.
Water Well Contractor: Address:
Is Public Water Supply available to site? .................................. ...............................
Yes Noe- -
Name of Public Water Supply: /V TownNillage
Distance to property from nearest water main:
Proposed well location & sources of contamination to be pr ided on separate sheet/plan.
Date.: _ - .:Applicaht.Signature: -- �.. -
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED -FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller ce ifie by Putnam
County.
Date of Issue Z, O Permit Issuin Official:
Date of Expiration 0 Title:
Permit is Non- TransfferrabR
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
NSULTING ENGINEERS
J. Donahue, P.E.
- — - -- 200 Breckenridge Road .
414.628.7576
TO
dIECTITIER (VF T1MUISG1 U Tt E.
oATe � �� _`,. •, . :,.: Boa No.
f ATYEN ?ION
Re
S'r?
WE ARE SENDING YOU Attached ❑ Under separate cover via —the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
'11L>\t
r
r
. THESE ARE TRANSMITTED. "as -checked :below:
pprovai O Approved as submitted O Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested 0 Returned for corrections ❑ Return corrected prints
❑ For review and comment 0
❑ FOR BIDS DUE _ _ 19 ❑ PRINTS RETURNED AFTER LOAN t0 US
REMARKS 0jor .._ .--.
COPY T0.__.___
SIGNED:
It anclosurss are not ♦s noted. kindly notify us at ones.
d f r
DANIEL \ IEL Jo pD� ®NAH LLJ E9 � P.E. n
120 Breckenridge Road
Mahopac, N.Y. 10541
914.628 -7596
June 11, 2001
Putnam County department of hgalth
Geneva Road
Brewster, N.Y. 10579
RE: SSTS Renewal
Property of Shedden
Sunset Hill Road
Putnam Valley
AT: Adam Steibling
Dear Mr. Steibling:
Enclosed please find three _.copies_of.the_S.STS.plan, certified-check and - renewal
application for the above. Your prompt attention would be appreciated.
Sincer ,
Daniel J..Donahue, P.E.. .
Site o Sanitary - Environmental
oi,
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
1GV- C♦ \•.. s.rRi• b . - r i• - a a . _. _ + - ...a'Y. c- -.S...s%N.- �4:- r'•�Y... r ;': Aso . .. .-...a .. .. ... w. a.v r ..rM . v
CONSTRUCTION PERMI QR-S , N E TREATMENT YSTEM
PERMIT # p� "�-f -% �!` , 01V, 3 S
A40
Located at Sa YSR—Ilym-e- BPD Town or Village 4��I�ylohl
Subdivision name ,5'/�Q1JI:;-:! Subd. Lot #.24 Tax Map (_ Block % Lot
Date Subdivision Approved J// i /yam
Owner /Applicant Name J - /tom PyO-V'
Renewal 4f Revision
Date of Previous Approval
Mailing Addres&Xd '0 N e-e j �f �%'r /S/ G w � �'�' / -'' L � '4-2 Zip Ieper
Amount of Fee Enclosed 9' '�e7,o
Building Type J j" / e -7,4,41 Lot Areal No. of Bedrooms _� Design Flow GPD��%1�
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of ( 0-2ro gallon septic tank and
Other Requirements:
To be constructed by ��y Address see,
Water Supply: Public Supply From Address WAN .7
-� car: Private Supply Drilled by° - ''%%7�- Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto. ,
Signed: - P.E. 1/ R.A. Date ? _
Address /V 4',%t,`-�,1'7- License #
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new permit. A proved for discharge of domestic sanitary sewage on
By Title: L_
4_2 _1C_ ' Date: '.� 2,
White copy - HD File; Yellow c - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
IFIL TNAM COUNTY DEPARTMENT ®IF HEALTH
IIDIIVRSIION OF ENVIRONMENTAL HEALTH SIERVRCIES
APPLICATM TO CONSTRUCT A WATER WELL
type.. ,. , _..._ - PCHD'Pe w -4
.. _ - ..., -
- rI111t "� .
Weal Loceflon:
Street Address: Town/Village Tax Grid #
Maple/ Block / Lot(s) �f /
�1oQIl Uwneir:
Name:
ress:
=ddl
_/ � J ���� dG- /�I�GL/ �C. l''`!:�/�j•� � C��� /fir/
U Wen:
� Residential Public Supply Air /Cond/Heat Pump Irrigation
zrzzlry
Business Farm Test/Monitoring Other (specify)
2- socomdairy
Industrial Institutional Standby
Ama mt of Use
Yield Sought gpm a Est. of Daily Usage 07i gal.
Reason ff®ir
Replace Existing Supply Test/Observation Additional Supply
IDiriMing
New Supply (new dwelling) Deepen Existing Well
IIDe0ed Reason
ffoir DdHiag
WeM Type
zfbrilled Driven Gravel Other
Is vell site subject to flooding? ................................................. ............................... Yes No
Is v ell located in a realty subdivision? ...................................... ............................... Yes d / No
1Vaae of subdivision %/ /iti Lot No.. �-
WaZr Well Contractor: / Address:
Is Public Water Supply available to site? .................................. ............................... Yes. No Z�,
Nave of Public Water Supply: iS/ 1-4 Town/Village
Dismnce to property from nearest water main: /V -
IF'ropsed well location & sources of contamination to be p vided on separate sheet/plan.
Dat: Applicant Signature:.
IELRMT TO CONSTRUCT A WATER WELL
Tlii]permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Pwam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
thavvithin thirty (30) days of the completion of water well construction, the applicant or their designated
a e;Ip�sentative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
r•�girrements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
�gocsied by the Putnam County Health Department. During all well drilling operations, the applicant and/or
wv�ltflriller shall take appropriate action to assure that any and all water and waste products from such
w�r�lclrilling operations be contained on this property and in such a manner as not to degrade or otherwise
c <avminate surface or groundwater.
AII2ROV EID.IFOR CONSTRUCTION: This approval expires two years from the date issued unless
c ®auction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amm oiled or modified when considered necessary by the Public Health Director. Any revision or alteration
cxf to approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
Cmlty.
aatof Issue i z Permit Iss ' O &au.:�
g :�k —
I>atof Expiratio t r o Title:
I11>@rntt ns Ikon- TirainsffenT blt
Wh; copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
L
DANIEL J. DONAHUE, P.E.
CONSULTING ENGINEERS
120 Breckenridge Road
Mahopac, N.Y. 10541
914-628 -7576
March 4, 1999
Putnam County Health Department
Geneva Road
Brewster, N.Y. 10509
Att: Adam Steibling
RE: SSTS Renewal
Lots 2A & 2B
Shedden R�
Sunsets Road
Putnam Valley
Dear Mr. Steibling:
■
. I . — ....._ _.....:.a
Enclosed please find the following for both lots 2A and 2B:
1. Construction permit
2. Well permit
3. Fee of $300 per lot xC Aenorle",j e,ged,r ya ,.&44.61,, Gran d4.,✓e�
4. Construction drawings consisting of two sheets
4
c j Ijt 1v o i1L-11 .6�
`Comirienfs` Your pTOiript attention to this matter would'he greatly appreciated: " -' .._........._. _ ._._..:.
Sincerel ,
Daniel J. D ahue, P.E.
Site o Sanitary . Environmental
F'UirsN s,n,1YT1 ,uF.NPAYT�!I.�'v"T mF f:1IF �V Tl3
�+. WY•9if'lIF';(
FSYryU$ A I 1 S- Tl4ir,1
N,x -xa�x
177— ..... ;'ice...
Date Subdivision AR roved Fee : Enclosed Amnt,nt
DWIMB nog, r � � D � � � �� � � 1� d M m
-- rF�
WO I Cx Aar
C �� c`�F'sz9�r rr
roprosant' that Cam wholly .ond' complately responsible for the design, and location of the Proposed . systom(s); 1) that the raporato di sal system
above dosc►ibod Grill bo constructed as'shown�on� tho approved amendment there tO And in accordance with tha_st4naords, rules o .regY n. -. � Haan
county. mo�avtlrien4. OP D-0�elth, arkA,thaQ,on•eompbtbai 2hovaoP_a "Carti4ieoto 09 Construction Compli,nco-- satisfactory to tho Commission= of Hcolthc;All
laa ecfumW4rd 1o,:4HO Dap rtwKr1Q, aft .o .arrilQOn 0learontoo will ®0 4urnishoo the oCrhC7, his sueoo=s, hoirsor assigns by the buildcv, that obit buleaw will
=Paco in :q l •Opdatmg eogwition any Dart of -mid Mwobo dispos5l system du iue8 the gloried of two (2) years immodlatoly PoltOarirtg thoi6to OP .tho Im u-
aaao oP the opoio�ol oP.Qho.,&kigkato of Construction Complionco oP lno wl'i stern or any r s Qhcvolo; 2) that the drillcfl wroll doi'co�8 abovo
tv"D bo e6cotod os i�ara on,th8 6poov plan and that mid wall aril) be Instal" is,99fordMeo _ with ndard s and rcaul0t%ns of the fvutnom
County Oc Xq Of, tQ '
Date SiBnad D.E. R.A.
"Addrom 3'o.Q.y
Lkenso Poo
aPPROVE0 FOR CONSTRUCTION: This, opproval oupiros two y from h date issuA-i construction of the building .has boon undortalcon and is
vovoeobla for cause; r may, o emended or modified when conSiB a r by the. Cer of F/glth. .Any ehang0 orlon o4 eorlseruetbn
vcmuivos a Hoar Da it ova® tov disDOeal oP domestk it , nd /or pr glply only.
Rev. r
10/88 ®ate By Titio
*.'...- ,...',. '�'= ' �a,`,�' we.,. �—"� '; a�'<. �a^ "x.."'"'c"ir• ":•:"c".r�"�r3C�"F ,.,,, y .:`"' ;,'..t'x c,�"'"'iTMa ., 1 J�.,^—a �^Y�r"• 'l i1. • I��'i'
IA
� r � � lOYi�IAM CODMY DSlA�TI' OF �r1LTH t� ` '' "ee Pwvld• [�w�ll'I � a �
t"1qmmWY91t 86WA DISIO/AL SYS= '� +
L•caMi V Av. 'I`elr� a ' Ymtt;e
r
.:. f,i
�it6iHilw let M` Tie Mip Bloeli �.
Renewal_
. O �evlal•e p
A
• nn // Daai of P" Appo vid
FIe`B Adatwi (} .:. L} X V; Cr Tmni y %� l/ '�°t'•" .iop 6 9'
Datg',9ubdjyiSi6n ARDrgaed Fee Enclosed ?.. AMQljnt
TA..!}; �P/%/^i�G/} i,•t Asrea .�`R r� Fm seetlm'o� Vabos
Nobar •[ Bet�a�e S Deaip'Flow G P D _� PC® Ndtlecatlm b �eai al When Fm b'a�ple�ed
sgwate s.waw S7 b onabt e[ llGv ., Qe9ai S�ptle T.a .ed G!
Walleir st y 0 Sop* Fa..
Adbeea
—J4,ab Sup* DOW by /�uKry y�N 4d,dreme
I
M _
I,r•p►•t•nt aMt 1 am wholly and completely responsible fp tM itesign and ldcjtion .o1'tM prdpopd system(t). 1) that the W, rat•'saw • di! Opioa stein
a0ow described will be'oorlstiuc:tid a$ shown on theapWowd amendment there to and in a' ccwGnc..w,ith tM.itarMaids, ruNt,a��regulations o • I
County - Department of IWftly and.that on_con pMtion.thaeof a'!Ci►tif" 4 of Construction Codlpllance" sitisf•ctory to the CommlplonN of NMlthwill
be uleniltted to tIN DeOartnsMlt, �nd,.;a -written guaran" will be' furnished 4e owner his wcoistoi; hekt of aaipit t+y the bulk!•!, that.sald.bl lwor will
piece in and „opsratilig oondition,any ppt -of- said, tawag• disposal "erh during;;the peiio0 of -two (2) yaws hltm•diately followln♦ tMdate of the ifau-
anp Of tM apprOiial of . tM, Certificate of Construction -C6rllpllanc• of , the originai . eM of my r•p•irs thereto; 2) that the drilled wall described 860”
,.
wile b• Meeted •t shorlip on;theapproved plan and thetsak) will will M Installed in,' nq .wiM the eta s, ,rules a rpu ions of the Putnam
'Couety'Deartlriw of ►Minh. .
Date X /�^l /�Y SNhb
`Address ` e L � '� . � p License No
APPROVED FOR CONSTRUCTION, This approval axpiret two yea from the date issued unless 'Construction of the building .has been undertaken and Is
revocable for pup or y Oe amerWeA or modified "10.11 co; 00 .ciliary Oy 'tfi �1�ner of Fiealie. Any change or alteration of construction
rm"Q t a Mw pami /�ACp ovs0'for dHpoYi of dorn. k
se Y /+Ye, and /_ er wpply only. 'Lev . � L .��.�s Title �, v
x!88 oat.
m
.Tr
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLIC MON "'TO CONSTRUCT A WATER WELL'
Prwn VVVMTT ik /" 4/ Ar,
WELL LOCAT %OAT
Street Address Village City Tax Grid Number
v G � d/,�G�iis- �� �e� /'t
WELL OWNER
Name Mailing Address
, d� owl.) ��� � % ���e%�°
rivate
® Public
USE OF WELL
primary
secondary
(,RESIDENTIAL 0PUBLIC SUPPLY OAIR /COND /HEAT PUMP
0 BUSINESS O FARM O TEST /OBSERVATION
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY
®ABANDONED
0 OTHER (specify
AMOUNT OF USE
it
YIELD SOUGHT�gpm /46 ��ED /EST. OF DAILY USAGE _gal
O REPLACE EXISTING SUPPLY ® TEST /OBSERVATION 12. ADDITIONAL SUPPLY
d&EW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
d', -4 A100`,v
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
F_wELL TYPE
ENDRILLED
DRIVEN
®DUG
OGRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
,.
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. 0*-
WATER WELL CONTRACTOR: Name j-0 ,G��.:� ��t�ir � Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES eNO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
Z. DISTANCE. TO .PROPERTY FROM..NEAREST WATER .MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
�[ON SEPARATE SHEET
date —
0
siena6ure
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirty (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling be contained on this
property and in such a manner as not to degrade or oth r t tam' surface or groundwater.
1. Date of Issue: P �r 19
Date of Expiration J 19 Pe it Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
V
GO
PUTNAM C OUNTY DEPARTMENT O F HEALTH
APPLICATION. FOR APPROVAL OF PLANS / FOR A WASTEWATER_ DISPOSAL SYSTEM
Name and Address ofM Applicant: �� rih a/ a/ J �da'►
G,
F,0 3e 22
Name of Project: CaNSTP00 -14N O -rr CAS 3. Location T /V /C:' I�U7r�,Y,C► !/q�k%y`'
. Project Engineer: A4ij 4 ,L DoyiWuF_. 5. Address: R1-D4 A-
License Number: ±L� ?/ Phone: �1 ,f9G
Type of Project:.
_ Private /Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty,Subdivision Other (specify)
Is this project subject to State Environmental Quality 'Review (SEQR)?
Type Status (Check One) Type I.. �_ Exempt
Type II. Un1fisted _X_
Is a Draft Environmental Impact Statement (DEIS) required? .....'. :...... /y O
Has DEIS- been completed and found acceptable by Lead Agency? Nf�
Name of Lead Agency
Is this project in an area under the control of local planning; zoning,
or other officials,.ordinances?
If so,'.have-plans been submitted to such authorities? .................. /y
Has preliminary approval been granted by such authorities? 11111 Date Granted:da
Type of Sewage.Disposal.'System Discharge...... Surface Water ,_Ground Waters
If surface water discharge, what is the stream class designation?........
Waters index number (surface) ........ ..:....
Is project located near a public water.supply system? .................. N 0
If -yes, name of water supply Distance to water supply
Is project site near a public sewage.collection or"d.isposal system ?.....
Name of sewage system N/A Distance to sewage system /VIA
Date observed :S f Su &D�a�sio /14 2' 3. Name of Health Inspector: E. SuAc���siu'y Nib
Project design flow (gallons per day ) ..................................... 0
2.
1.5. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.._ 6L0
-6. Has SPDES Application been submitted to local DEC Office? ............... A
7. Is any portion of this project located within a designated Town or State
wetland ?..... ....... ..............................
S. Wetland ID Number ................. ...............................
9. ,Is 'Wetland Permit required? ...................
Has application been made to Town or Local DEC Office? .......:..........
0. Does project require a DEC Stream Disturbance Permit ?. ................... AM
1. Is or was.project site used for agricultural activity involving application Sg f r.a?o�v�t,�.�
of pesticides to.orchards or other crops, solid or hazardous waste dispo al ,
landfilling, sludge application or industrial activity? ........ YES o.rO
Is project located within 1,000 feet of existence of abandoned landfill, S�'e� Sv�0�vi•t�aN
hazardous waste site, salt stockpile, :landfill, sludgg.disposal site or
any other potential known.source of.contamination? ...............YES orP
DESCRIBE: d
Is there a local master plan or file with the Town or Village? E-r_
'. Are community water, sewer facilities planned to be developed within 15 years?
Are any sewage disposal.areas in excess of 15X slope? .
. l/
Tax Map ID Number . .............+... ...... ...............................
Approved Plans are to be returned to: Applicant _ Engineer
the application is signed by a person other than the applicant shown in Item 1, the
3lication must be accompanied by a Letter of Authorization. Failure to comply with this
-)vision may be grounds for the rejection of any submission.
F hereby affirm, under penalty of perjury, that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a'Class A lisdemeanor pursuant to Section 210.45 of
the Penal Law.
;NATURES & OFFICIAL TITLES:
ee
LING ADDRESS: _4eo917010/ 1 -c A- y /a f t¢/
1. . COUNTY COU DEPARTMENT OF BMTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN PAT
STAGE DISIPO
_54,$YSTEK
Owner tq,',f 14,q-,,?D Address
Located at (Street) jr A_tll. 6ec-. Block Lot �J,
(indicate nearest cross street)
Municipality P & IV I!X,s - -' f" r Watershed
14141410211 .00; • • Unto-.11gKou
Date of Pre-Soaking Date of Percolation Test
HOLE
KVBER CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water From Water Level
No. Time Ground Surface In Inches Soil Rate
Start-Stop Min. Start stop- Drop In Min/In Drop
Inches Inches Inches
c;� -4— .2
2/ao Z,ra
3/ r'cZ*t r Y t 2 ,z
30 . (.).,Y
4a
2
3
4
5
NOM: 1. Tests to be repeated
are ;obtained at each
for review.
2. Depth measurements to
rev. 9/85
at same depth until approximately equal soil rates
percolation test hole. All data to'be submitted
be made from top of hole.
C�
CZ
17
4J"'
c),V
92
5
2
3
4
5
NOM: 1. Tests to be repeated
are ;obtained at each
for review.
2. Depth measurements to
rev. 9/85
at same depth until approximately equal soil rates
percolation test hole. All data to'be submitted
be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEP'T'H --- HOLE 'N0.
G.L.
1'
2'
3'
4'
5'
6'
7'
8'
9'
10'
ill
12'
131.
HOLE= NO.- 3...__ HOLE!-NOo,
INDICATE LEVEL AT WHICH GROUNDWATER IS ENC0UNTERED /jo Al
INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: e� nJ ! F! ,� . 0 �� f� /1��= DATE:
DESIGN
Soil Rate Used f? Min /1" Drop: S.D. Usable Area Provided
No. of Bedroans 3 Septic Tank Capacity gals. Type C<
Absorption Area Provided By ,?6 L.F. x 24" width trench
Other
Name 12,9 Al 1-F Z- Z D v i Signature
Address X661 SEAL
KhM�H AN]
THIS SPACE FOR USE BY HEALTH D
Soil Rate Approved `sq.ft /gal. Checked by Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICAT -ION . TO-CONSTRUCT A -WATER - WELL
PCHD PERMIT # /!_/
WELL LOCATION
Street Address
�7 /-//GL R
Lou lage City Tax Grid Number
GG
WELL OWNER
Nam Mailing
Address
j Private
Public
E OF WELL
primary
2- secondary
,'RESIDENTIAL 0 PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
D BUSINESS 0 FARM p TEST /OBSERVATION
0 INDUSTRIAL O INSTITUTIONAL 0 STAND -BY
0 ABANDONED
0 OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT �S'+' gpm /#
.770oT1i.Try+%
REULED /EST. OF DAILY USAGECr Sal
REASON FOR
DRILLING
0 REPLACE EXISTING SUPPLY
4?i:NEW SUPPLY NEW DWELLING
TEST/ OBSERVATION 13. ADDITIONAL SUPPLY
13 DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
ID10O Ce
WELL TYPE
UPRILLED
D DRIVEN
DUG
[]
GRAVEL.
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
cS"WPd19 /,;,y Lot No.
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: / / TOWN /VIL /CITY
.DISTANCE-TO PROPERTT:._FROM,,NEAREST; WATER MAIN: _ -_ r -•
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
( ate) (signat
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt3, (30) days of the completion of water well construction, the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant
any and all water or waste products from such well
property and in such a manner as not to degrade o
Date of Issue: 19 q
Date of Expiration /•� 19 4
shall take appropriate action to assure that
drilling operations be contained on this
r oth /erw e conta ate surface or groundwater.
Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
PUTNAM COUNTY DEPARTMENT OF HEALTH
APPENDIX K
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property of
Located a t , Md_1'j' e-r
(T) G %�•�' �/''GG% ection_Z' �Block .. Lot
Subdivision of cs�fjl���/4/
Subdvo Lot # c2 /4440RFiled Map # alc L 0 Date
Gentlemen:
This letter is to authorize.i�r��
a duly licensed professional engineer or registered architect
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
;.. - systein�_ori "- system5:_3n conformity wit r e_ provisions. _o _ v.Article. 145 or _
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned• ,
PeEo, RoAe, #
A dress
Very truly yours,
Signed i6
Owner of Projerty
Address
&nm W r
Town
Z::� �_/,y . &� (f-
Telephone
T le phone
!! _
fTCH BAT o oo NING a BATH BED,RMXI .
m.nv Q sI O ia.nv CZ asu
�• "� BED RM' I KITCHEN DINING
HALL Cr
LIVING RM .+ d
+• ++ BED RM ' 2 BED RM� 3 LIVING RM
BED RM'3 - BED RM
lit, It IIIJI. 6
F.
e
CRESTWOOD 27 'x48' - ELMWOOD 24 x46'
;,
X BATp�
NOOK re O BATH
DINING KITCHEN p s ••f s�.au
aa.av au. no : BED RM ' I DINING. 0 O BED RM I
Q� oa+au n.av KITCHEN. e.au
' OBAT `1 I
�UTNAs�H�L�UNTa D ,PST :Et�iT HALL
LIVING RM iT ,f;hY*' }�' f'BEQ RM �Vj'r- LIVING RM '• BED RM�2,�
nt.us - BEB•RM,a3 I so:iao' J mu.oa n
w — BED iRM'3 ust uu
RFOR �Mro�ulivT U LY
I I t; -,USA .,
_ _—
L�Pc i^i 1tIE'
GLENWOOD 27x48'' LYNWOOD 27'x52
® ®. PENN LYON HOMES INC. .
Old Trail Road, Selinsgrove Pa. 17870
Telephone (717) 743-0111'
PUTNAM COUNTY DEPARTMENT OF HEALTH
APPENDIX K
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of
Located at ,0 iIS f / / /�/� � T
(T ) �1�'�i //�LG %erection - Block Lot / f�
Subdivision of ��'�lf /it/��x5;;AA/
Subdv. Lot # r�' ,, .2R Filed Map # Date
Gentlemen:
This letter is to authorize "� " y G C/f vim,
a duly licensed professional engineeror registered architect
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards,. rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
sy &t- em- &- -in -- conformity with • the 'provisions o£ ":�i �t cle_ 145 .or ..
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersigned*
PeEo, RoAe, #
Address
Te phone
Very truly yours,
Signed
Owner of Proferty
P.O. grz
r
6agiv/ A06-79
Town
9114i a ..' ..
Telephone
APPENDIX 3
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATEIL SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
- - 'VIEW HE --for-CONSTRUI::TION,,PEYHMIT _ ,......_ .,..:
STREET LOCATION �" NAME OF OWNER
BY B. HEDGES R.MORRIS OTHER DATE _/� TAX MAP #
DOCUMENTS.
M'P
- �C
ERMIT APPLICATION1�
m PC -1
m WELL PERMIT PWSIEITER
ED ENGINE UTHON j/_
SIGN n ,4 (DDS)
CRATE RESOLUTION
PLANS THREE SETS
MOUSE PLANS - TWO SETS
VARIANCE REQUEST
SUBDIVISION
LEGAL SUBDIVISION
- SUBDIVISION APPROVAL CHECKED
PERC RATE
- i L REQUIRED DEPTH
IdJ CURTAIN DRAIN REQUIRED MSTANDPIPES
GENERAL
EX- APPROVAL SSDS ADJ. LOTS •
MWETLAND (TOWN/DEC PERMIT R & D)
DATA ON DDS PLANS & PERMIT SAME
110 �-�j PRE- 1969 - NEIGHBOR NOTIFIFICATION
:I .I/ L.L".R.BVZBA
M 100 YR. FLOOD ELEVATION
REQUIRED DETAILS ON PLANS
EWAGE SYSTEM PLAN - (NORTH ARROW)
SDS HYDRAULIC PROFILE m GRAVITY FLOW
ONSTRUCTION NOTES (GRINDER*ATE)
ESIGN DATA: PERC AND DEEP RESULTS
WO -FOOT CONTOURS EXISTING & PROPOSED
AY & SLOPES CUT
L�1 FOOTING /GUTTER/CURTAIN DRAINS
DD�EROSION CONTROL; HOUSE,WELL, SSDS
OSION CONTROL NOTE
ERC & DEEP HOLES LOCATED
F/t REPRESENTATIVE OF PRIMARY AND EXPANSION
rL
1�4
Y x
SHO ; GRAVITY FLOW, SUFF.SIZE
PIT & D BOX SHOWN & DETAILED
HOUSE - NO. OF BEDROOMS
WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM
PROPERTY METES & BOUNDS
OUSE t1 CESSARY (TIGHT LOT)
�0 -SEWER - 1 4 "0; TYPE PIP �YI'L sime
NO B BENDS 45 W /CLEANOUT
FILL SYSTEMS
LAYBARRIER
10 FT HORIZONTAL: SLOPE 3:1 TO GRADE
FILL SPECS m FILL NOTES
FILL CERTIFICATION NOTE
DEPTH GAUGES
FILL PROFILE & DIMENSIONS
VOLUME
FILL IN EXPANSION AREA
TRENCH
F TRENCH PROVIDED 4�' b0 FT MAX
P - CONTOURS
100 %.EXP ON PROVIDED -
SEPARATION DISTANCES SPECIFIED ON PLAN
10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL
26' TO FOUNDATION WALLS fti 15' WELL TO P.I
100 TO WELL, 200' IN D.L.O.D., 150' PITS
100 TO STREAM WATERCOURSE LAKE (INC.EXPAN)
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
10' TO WATER LINE (PITS -20')
50' INTERMITTENT DRAINAGE COURSE
200 FT. RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS
15' MIN TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2%,35' - 1%,100' <1%
20' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS,
10' FROM FOUNDATION; 50' TO WELL
DANIEL Jo DONAHUE, RE.
CONSULTING ENGINEERS
_ ..... �.-,.. s ....120 Breckenridge Road.. _ _ ....:. �.., ..... r , ... .;
Mahopac, NX 10541
914 -6628 -7576
August 12, 1994
Putnam County Department of Health
6 Geneva Road
Brewster, N.Y. 10509
Att: Robert Morris, P.E.
RE: SSDS Permits
Lots 2A & 2B
Shedden Subdivision
Putnam Valley
Dear Mr. Morris:
Enclosed, herewith, please find the following material in
support of applications for permits for the above captioned
lots:
1. PC- Form{
2. Application of permits two construct
3. Certified check for $600.00 for both lots
4. Application for a well permit-
5. Design data sheet
6. Letter of authorization.
7. Four sets of construction plans
S. Two sets of house plans
Your prompt attention to this matter would be greatly
appreciated.
Sinc y, .��
aniel J. Donahue, P.E.
Site 0 Sanitary 0 Environmental
A
�
DANIEL Jo DONAHUE, RE.
CONSULTING ENGINEERS
_ ..... �.-,.. s ....120 Breckenridge Road.. _ _ ....:. �.., ..... r , ... .;
Mahopac, NX 10541
914 -6628 -7576
August 12, 1994
Putnam County Department of Health
6 Geneva Road
Brewster, N.Y. 10509
Att: Robert Morris, P.E.
RE: SSDS Permits
Lots 2A & 2B
Shedden Subdivision
Putnam Valley
Dear Mr. Morris:
Enclosed, herewith, please find the following material in
support of applications for permits for the above captioned
lots:
1. PC- Form{
2. Application of permits two construct
3. Certified check for $600.00 for both lots
4. Application for a well permit-
5. Design data sheet
6. Letter of authorization.
7. Four sets of construction plans
S. Two sets of house plans
Your prompt attention to this matter would be greatly
appreciated.
Sinc y, .��
aniel J. Donahue, P.E.
Site 0 Sanitary 0 Environmental
A
e w. .. vv. ... , x....•a .a « .,... a .. °Sr 'fiQ" FiC�' Jr.: Pf_ M.$.- : a •I
AM;c HwM Okwoi
DEPARTMENT OF-HEALTH
-Division Of Environs eniai Health Services
4 Geneva Road, Brewster,. New York 10509
(914) 278 -6130
August 30, 1994
Dan Donahue
120 Breckenridge Road
Mahopac, W 10541
Re: Proposed SSDS: Sheddon
Lot 2A Sunset Hill Road
(T) Putnam Valley
Dear Mr. Donahue:
Review of plans and other supporting documents submitted at this time relative to
the above- captioned project has been completed. Comments are offered as follows:
"The construction of this sewage disposal system may be subject to local wetlands
regulations. You should contact local wetlands officials in this regard."
Provide current tax map number.
File map number and date has not been provided
e!3. Design data sheet has not been completed. 'Complete design section and
resubmit (form enclosed)
✓4. Erosion control measures for the house, well and SSDS are to be shown on the
plan along with a note stating all erosion control measures will be installed
prior to the start of any construction.
=Curz-ent- 'oodes%reqaires a •1005 expansion - area•, - -pl
an- notes ..expansion.,- area,
f Reference to subdivision file is not acceptable on form PC -1.
9. Remove note #6
X48. House sewer is to note having a minimum slope of 1 /4 " /ft or 2%.
Upon Receipt of a submission, revised to reflect the above its, this
application will be considered further.
I 'y: RM /j P
Ver truly yours,
Robert Morris, P. E.
Public Health Engineer
� q
BRUCE , R.S.
Aciing Public Health Director
r
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130 OctobeO1, 1996'
Dan Donahue
200 Breckenridge Rd.
Mahopac, NY 10541
Re: Proposed SSDS: Sheddon
L--bt 2A
;Sunset Hill Road
i (T) Kent
Dear 1%,Zr, Donahue: '
'Review of plans and other supporting documents submitted at this time relative to the above -
captioned project has been completed. Comments are offered as follows:
"The construction of this sewage disposal system maybe subject to local wetlands regulations.
You should contact local .wetlands officials in this regard."
1. Current codes requires the maximum scale. to be 1" = 30'.
2. Standard notes are not legible.
Upon receipt of a submission, revised to reflect the above, this application will be considered
further.
RNI/jp
Ve truly yours,
Robert Morris, P. E.
Public Health Engineer